A young child’s inability to engage in therapeutic play displayed triggers into anxiety when his behaviors became chaotic and unmanageable. How he found help was a beautiful collaboration between two of Community Care Programs finest. Dr. Donna Rifken and therapist Cheryl Hunt.
Dr. Donna: Cheryl, do you remember how Rebecca (foster parent) described 5-year old Caleb to us when he was placed in her home? She, one of our most experienced foster parents for young children, characterized him as one of the most physically hyperactive, aggressive, and ‘feral’ children she had ever cared for.
He ran through the house, stomping on toys, kicking cats, spitting at other children, and grabbing food with his hands from the family platter. He had trouble settling for sleep at night, jumping from bed to bed, refusing to lie down, and getting up multiple times in the night with bad dreams or just to run around the house.
Ms. Cheryl: Yes, I sure do. We wondered how this little one could have survived as much trauma as he had experienced and still be able to settle around adults at all.
A traumatized child’s body can do all the communicating.
Because his trauma began when he was just a baby, he had no words to express his fear, worry, and anger. His body did all the communicating, showing us how distressed he felt. This kind of disorganized and intense movement often reflects ‘inside feelings’ of panic and terror.
Dr. Donna: I saw him first and began Trauma-Informed Child Parent Psychotherapy (TICPP) with Caleb and his foster mother to explore the traumatic memories we knew about and desensitize him to the fear and anxiety that these memories constantly triggered in his body.
I used Playmobil characters to play out some of the bad memories he shared or that I knew about. We always created a healing, safe ending with his foster mom as part of the story. But honestly, I struggled to help Caleb use play and words to describe his ‘inside feelings’.
Helpers, like police officers, became hurters for no reason. Ambulance drivers began running over injured patients tossing them into the air, and nice dads morphed into bad dads with evil-sounding laughter.
At other times, he would become helplessly silly, turning his back on me, and laughing or bouncing around the room until an adult had to physically hold and rock him.
TICPP is a great intervention for children who can tolerate organized play with a beginning, middle, and ending, or at least some discernible sequence. But I struggled to help him find a way of organizing his thoughts and behaviors so he could play out a story.
Ms. Cheryl: Yes, that was the problem – he was used to enacting his distress with his body and had no experience moving and thinking in ways that could feel soothing or calming.
If he couldn’t move in organized ways, how could he feel that way? Think about it. Movement itself facilitates communication.
After a fun movement experience, we all tend to be more talkative. Phone companies realized many years ago that movement facilitates communication, so they untethered the phones to allow us to walk and talk. We process feelings and thoughts better when we move.
Foundational “downstairs brain” skills support higher level functions, like thinking and feeling. We began moving rhythmically in the womb and we’ve depended on movement to help sequence and orchestrate our development ever since.
Movement is crucial to every other brain function, including memory, emotion, language, and learning” (Ratey, 2001).
Dr. Donna: You had the brilliant idea of scheduling Caleb’s OT sessions right before his TICPP sessions with me. I can tell you that it’s made a huge difference in Caleb’s ability to engage in therapeutic play with me and his foster father.
He arrives to the session looking and moving in a more fluid, easeful way. He is less likely to dissolve into silly avoidance and helper characters haven’t morphed into hurters in months.
Now that his body seems to have found comfortable rhythms, his words are more available to him. He and I have begun some Trauma Focused Cognitive Behavior Therapy, adapted to younger children, and he is beginning to find words to express his ‘inside feelings’.
Ms. Cheryl: That’s exactly what we hoped for, isn’t it? The mind can’t understand what the body hasn’t received or encoded.
When we start by focusing on physical movement and sensory processing, we help to bring organization and rhythmicity to the body. When this happens, the mind can calm.
The body is a portal to the mind and the mind can be a portal to the body. We are one organism and connecting the body and mind allows us to make the most of our human talents and resources.
Here at CCP, we continually strive to seek creative solutions for reaching those kids that appear “unreachable”. Our latest discovery is that Occupational Therapy alone and Mental Health treatment alone may be ineffective. However, when we combine these two interventions (on the same day) - MAGIC!
It can be challenging for parents and kids to run around to multiple behavioral, mental health, occupational therapy, DBT group therapy and other specialized treatment appointments throughout the week or month.
The kids miss a lot of school and the parents have to take time off of work or sacrifice other personal needs.
When kids don’t respond to one type of treatment, well-meaning teams sometimes fall into the trap of loading the youth or family up with lots of different services. This “more is better” thinking can result in burned out kids, parents and service providers.
What if we strategically chose a combination of interventions such as back-to-back Occupational therapy/Psychotherapy sessions in the same day, that is targeted to the youth’s specific needs instead of just throwing more services into the mix? Well, as this particular case demonstrates, it can be - MAGIC!
If you would like to consult about a case that could benefit from a combination of treatment interventions such as the case outlined in this article, please contact us.